Diagnosis of Polyneuropathies

Abstract

The most important recommendations at a glance: History and clinical findings provide the most important data for the classification of polyneuropathies (familial, acute versus chronic course, concomitant disease; involved organ systems, symmetrical versus multifocal etc.) (IV) (C).

Electrophysiological examination is necessary to determine the pattern of distribution and the type of lesion (axonal versus demyelinating) in order to detect specific patterns of damage (e. g. conduction blocks) and to assess the resulting degree of muscle damage („denervation”) (B).

Laboratory tests should include the most important treatable polyneuropathies (see below) (C).

The examination of CSF is useful in the differential diagnosis of inflammatory polyneuropathies (B).

Genetic examinations are warranted in the case of a positive family history for polyneuropathy or in the presence of typical signs of hereditary polyneuropathy (pes cavus or hammer toes).

Nerve biopsies are recommended in the case of suspected treatable polyneuropathy that cannot be diagnosed by other means (e. g. vasculitis, atypical CIDP, amyloidosis). Nerve biopsies should be performed and analysed only in specialized centers (C).

When considering small fiber neuropathy, quantitative sensory testing and quantification of skin innervation are helpful diagnostic instruments.

Keywords

polyneuropathies - definition - manifestation types - clinical examination - differential diagnosis - neurophysiological examination - muscle and nerve biopsy - skin biopsy - genetic testing - laboratory tests

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